An approach to evaluating adolescent adaptive processes: Validity of an interview-based measure

The authors present an initial exploration, of the validity of 15 scales designed to assess adaptive ego processes in adolescence. These scales are rated solelyThis study was supported by the Youth Development Project of the Joslin DRTC (NIH AM 20530-01), grants from the Psychoanalytic Research Fund of the American Psychoanalytic Association, the Spencer Foundation, the MacArthur Foundation, the Harris Trust, National Instutute of Mental Health, a Research Scientist Award (K-05-MH-70178) (Dr. Hauser), the Maternal and Child Health Research Grants Program, and a Faculty Scholar Award of the William T. Grant Foundation (Dr. Beardslee).Clinical director, Department of Psychiatry, The Children's Hospital; and assistnt professor in psychiatry, Harvard Medical School. Received M.D. from Case-Western Reserve University. Currently studying adaptation and intervention with youngsters at high risk for psychopathology.Chief of psychiatry, Joslin Diabetes Center; and associate professor in psychiatry, Harvard Medical School. Received M.D. from the University of Chicago. Currently studying psychosocial consequences of diabetes mellitus.Associate professor in psychiatry, Harvard Medical School. Received M.D. from Yale University and Ph.D. from Harvard University (psychology). Currently studying family contexts of adolescent development and outcomes in diabetic adolescents.Director of evaluation research, The Children's Unit of McLean Hospital. Received Dipl. Psych. from Freie Universitat, Berlin (clinical psychology); Ed.D. from Harvard University (School of Education). Currently studying relationships between psychopathology and development among adolescent psychiatric patients.Research associate, Henry A. Murray Research Center of Radcliffe Colleges; and instructor of psychology, Department of Psychiatry, Harvard Medical School. Received Ed.D. from Harvard University (School of Education). Currently studying adolescent and family coping processes in response to stressful events.Currentlyand tudying research methodology and statistics.M.S.W., Smith College School of Social Work. Currently attending Dartmouth Medical School.     

Cost-effectiveness analysis in the courts: recent trends and future prospects

This article provides an initial look at how managed care organizations (MCOs) might incorporate cost-effectiveness analysis (CEA) into their decision-making process and how the courts might respond. Because so few medical liability cases directly involve CEA, we must look at other areas of the law to assess potential MCO liability for applying CEA. In general negligence cases, courts rely on a risk-benefit test to determine customary practice. Likewise, in product liability cases, courts use a risk-utility calculus to determine liability for product design defects. And in challenges to government regulation, courts examine how agencies use CEA to set regulatory policy. The results have been mixed. In product liability cases, CEA has led to some punitive damage awards against automobile manufacturers. But courts have integrated it in negligence cases without generating juror antipathy, and generally defer to agency expertise in how to incorporate CEA. The article discusses the implications of these cases for MCO use of CEA and outlines various options for setting the standard of care in the managed care era.